Despite the burden of depression in home health care, very few home health patients receive guideline-concordant depression treatment. Lack of economic incentives constitutes a major barrier to the implementation of evidence-based depression treatment models in general medical settings including home health care. The NIMH-funded "Homecare Depression Care path" (CAREPATH) randomized controlled trial will test the effectiveness of an evidence- based depression care management intervention tailored to the home health setting versus usual care. The goal of this proposed research is to understand the economic incentives for adopting the CAREPATH intervention by home health agencies (HHAs). The specific aims are: 1) to assess the incremental cost to HHAs of delivering the CAREPATH intervention to clinically depressed home health patients, including CAREPATH training cost, cost of nurse time devoted to CAREPATH intervention and the cost impact of changes, if any, in the number and types of home health visits as a result of the intervention;and 2) to estimate incremental payments associated with the CAREPATH intervention under the current Medicare home health prospective payment system (PPS) and compare these payments to the cost of the intervention. Data for this project will come from linked home health administrative databases assembled by the CAREPATH study and study nurse self-reports of time spent on CAREPATH activities. We will leverage the randomized controlled design of the CAREPATH study to estimate incremental visit costs and incremental payment associated with the CAREPATH intervention at the level of home health payment episode, taking into account the multi-level nature of the data (episodes, patients, nurses and nurse teams). Results of the study will inform the decisions of HHAs in adopting the CAREPATH intervention if it is found to be effective, thus addressing a prominent barrier to the implementation of evidence-based depression care in routine medical practices. Findings will also inform the design of Medicare payments that can encourage the provision of effective depression treatment in home health care. PUBLIC HEALTH RELEVANCE: Depression among older home health care patients is prevalent and costly, but seriously under- recognized and undertreated. The proposed study will estimate, from the perspective of home health agencies (HHAs), the incremental costs and payments associated with a depression care management intervention currently being tested in home health care. Findings of this project will inform the decision of HHAs in providing evidence-based depression care and the design of Medicare payments that can encourage the provision of effective depression treatment in home health.